An update on the latest chemical therapies for reflux esophagitis in children

ABSTRACT

Introduction: Gastroesophageal reflux (GER), and its complicated form gastroesophageal reflux disease (GERD) is a common condition in infants and children. As GERD is often considered to cause extra-oesophageal symptoms in children and in the absence of standardized diagnostic and treatment algorithm, many children are inappropriately exposed to empirical anti-reflux treatments, with Acid-Suppressive Medications (ASM); mostly proton pump inhibitors (PPIs).

Areas covered: The authors summarize the pharmacological management of pediatric GERD and discuss the efficacy of PPIs as randomized controlled trials have failed to demonstrate their clinical efficacy in the pediatric population. They consider the controversies surrounding the use of PPIs in the pediatric population as increasing evidence suggests of, although controversially, an increased risk of adverse events such as infection of the respiratory or gastrointestinal tract. Esophagitis is a complication that has a significant impact on weight gain and growth, as well as on the quality of life, and in such case, the benefit of treatment largely outweighs the risk.

Expert opinion: Clinicians should reserve ASM use for infants and children with proven esophagitis and avoid their routine use in patients with merely symptoms of GER. Treatment need and options must be frequently re-evaluated to reduce the risks associated with ongoing therapy.

KEYWORDS:

• Esophagitis
• children
• PCAB
• baclofen
• proton pum inhibitors
• safety

Article highlights

• When associated with bothersome Gastroesophageal reflux becomes a disease. Therapies, mostly with acid suppressive therapies are not needed in the absence of warning signs if there is no impact of the symptoms on feeding, growth or on normal development.

• Initial management relies on non-pharmacological measures including food thickeners, reduction of food volume, and prohibition of overfeeding.

• When pharmacological management is deemed necessary, antacids or alginate should not be used.

• In infant with GERD the benefit of PPI or H2RA, is uncertain, as is the risk. These medications should not be used for symptomatic GER in otherwise healthy infants.

• When ASM is being used, efficacy has to be reassessed to search for alternative cause in infants and children not responding after 4 to 8 weeks of optimized medical therapy.

• Despite specific warnings for lung and digestive infections in children receiving PPIs or H2Ras, the level of evidence is weak and must not prevent for treating reflux esophagitis as needed.

• Medications targeting transient lower esophageal sphincter relaxations (TLESRs) are an interesting but uncertain approach to manage the origin of GERD.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.